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Auditory Verbal Hallucinations in Schizophrenia Katherine Joiner University of Mississippi, [email protected]

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Auditory Verbal Hallucinations in Schizophrenia Katherine Joiner University of Mississippi, Kmjoiner@Go.Olemiss.Edu University of Mississippi eGrove Honors College (Sally McDonnell Barksdale Honors Theses Honors College) 5-10-2019 Auditory Verbal Hallucinations in Schizophrenia Katherine Joiner University of Mississippi, [email protected] Follow this and additional works at: https://egrove.olemiss.edu/hon_thesis Part of the Communication Sciences and Disorders Commons Recommended Citation Joiner, Katherine, "Auditory Verbal Hallucinations in Schizophrenia" (2019). Honors Theses. 1145. https://egrove.olemiss.edu/hon_thesis/1145 This Undergraduate Thesis is brought to you for free and open access by the Honors College (Sally McDonnell Barksdale Honors College) at eGrove. It has been accepted for inclusion in Honors Theses by an authorized administrator of eGrove. For more information, please contact [email protected]. AUDITORY VERBAL HALLUCINATIONS IN SCHIZOPHRENIA By: Katherine Joiner A thesis submitted to the faculty of the University of Mississippi in partial fulfillment of the requirements of the Sally McDonnell Barksdale Honors College Oxford, MS May 2019 Approved by: ________________________ Advisor: Dr. Tossi Ikuta ________________________ Reader: Dr. Gregory Snyder ________________________ Reader: Dr. Vishakha W. Rawool 1 © 2019 Katherine Joiner ALL RIGHTS RESERVED Acknowledgments 2 I would like to thank Dr. Ikuta for always believing in me through this whole process. I could not have done this without you. Working with you has been an honor and I have grown so much through your guidance. Thank you for everything. Dr. Snyder, you have been one of the most influential professors that I have had at this University. Your care for your students is shown everyday and it is not unappreciated. Thank you for showing me what it means to be a professional, but still have a good heart. Dr. Rawool, to have you read over something that I wrote is a huge honor for me. I would like to say thank you for being so kind and taking time out of your busy schedule to do this for me. I look forward to growing into a professional under your guidance in the upcoming years. 3 Abstract The primary auditory cortex being linked to the AVHs could be due to it being overly sensitive when being stimulated by processing found internally, opposing to outward stimulation. The 173 individuals who were available for both structural data and resting state, 83 were found to have schizophrenia or schizoaffective. Resting state echo planar image (EPI) volumes had 32 slices of 4mm 64x64 matrix with 4mm thickness (voxel size = 3x3x4mm), with repetition time (TR) of 2000ms and echo time (TE) of 29ms. A total of 150 volumes (5 minutes) were used in the analysis. The auditory cortex in the SZ group showed significantly weaker connectivity to the right supracalcarine cortex, left lingual gyrus, and right precuneus cortex and significantly stronger connectivity to the right caudate. 4 I dedicate this paper to my parents. Thank you for always being there for me, supporting me, and loving me through it all. I couldn’t have gotten where I am today without you both. This one’s for y’all. 5 TABLE OF CONTENTS: Introduction…………………...…………………………………………………...7 Materials and methods……………………………………………………………9 Results……………………………………………………………………………...11 Discussion………………………………………………………………………….13 6 Introduction Auditory verbal hallucinations (AVHs) have a way of making the patient feel like they are actually hearing the auditory stimulant rather than seeing pictures, images, or memories from the past. This phenomenon has lead researchers to believe that the primary auditory cortex plays a critical role (Kristiina et al. 2013). The primary auditory cortex being linked to the AVHs could be due to it being overly sensitive when being stimulated by processing found internally, opposing to outward stimulation. This finding can lead one to assume that the primary auditory cortex, when it is scaled back, will not activate to outward sounds which leads to the AVH (Kristiina et al. 2013). Neuroimaging studies have been conducted to examine brain regions that are activated during AVH. The auditory cortex was one of the regions that were activated during AVHs, suggesting that the individual is experiencing sensation of hearing. The primary auditory cortex has been shown to be activated during lip-reading and imagination, showing that the external stimuli are not necessary for the primary auditory cortex to be activated. The auditory cortex in schizophrenia may be sensitized. Postmortem studies have shown that the auditory cortex neurons have had morphological alterations in patients that have schizophrenia. AVH, when in response to actual outer stimuli, are used as one of the most recognized symptoms of schizophrenia (American Psychiatric Association, 1994). During the AVH, the primary auditory cortex in the dominant hemisphere was seen as being active (Dierks et al., 1999). This suggests that there when there is an AVH there is also a language-related process (Stephane et al., 2001). This notion is reinforced by the finding that when hallucinating, schizophrenic 7 patients have changes in the language-related areas, specifically in the white matter fiber tract that is connecting those areas (Hubl et al., 2004). Processing deficits when dealing with auditory sensory matters, have been found to be in direct correlation with gray matter loss in the Heschl's gyrus (Salisbury et al., 2007). Gray matter has been shown to be lost at a greater amount when the patient is found to have had schizophrenia for a longer amount of time. This could be linked to a long term use of antipsychotic medications (Vita et al., 2012). Studies have shown that when there is a reduction in the auditory cortex volume, there is a correlation with auditory hallucinations in patients with schizophrenia. Auditory hallucinations have been linked to having a thinner cortex, but not a smaller surface area of the left Heschl’s gyrus (Mørch-Johnsen et al. 2017). Changes in the auditory cortex is strongly indicated. The auditory pathway has been linked to sending sound signals to the cochlea, leading to the hallucinations being heard as though the sound was coming from outside of the ear (Ikuta et al. 2015). Schizophrenia has shown to have stronger connectivities of the Nucleus Accumbens (NAcc) which can be associated with hallucinations (Rolland et al., 2015). This has lead to the association between the NAcc and visual integration of speech into schizophrenia (Szycik et al., 2009). Sartorius et al. found that hallucinations within the first month of symptoms with schizophrenia surpases 70%. 25-30% of the patients are non-responsive to medication and in return are having trouble living everyday life (Shergill et al .,1998; Copolov et al ., 2004). Examining functional connectivity of the brain provides knowledge that would not be available otherwise. The brain is a vast network filled with connections that have 8 been studied extensively. Cognitive deficits have been shown in schizophrenia, even before the official diagnosis or the first sign of psychosis (Brewer el. Al., 2016). A genetic factor has been linked to the cognitive deficits found in patients with schizophrenia. Their family members have been shown to also have the cognitive deficits that are seen in the patients (Snitz et al., 2006). These cognitive deficits are seen in daily life (Bowie et. al.,2006) and show no signs of being related to any other of the symptoms typically found in schizophrenia (O’Leary et al., 2000). The cognitive deficits can be linked to memory, processing speeds, and executive functioning (Mesholam-Gately et al., 2009, Reichenberg and Harvey, 2007). Despite that the auditory cortex has been shown to be affected in schizophrenia, it remained unclear whether schizophrenia exhibits different functional connectivity. In this study, we tested functional connectivity of the auditory cortex, using resting state functional MRI data of individuals with and without schizophrenia. Materials and Methods Data Acquisition The Center for Biomedical Research Excellence in Brain Function and Mental Illness (Çetin et al., 2014) was where the data for the MRI Images, demographics, and clinical data were obtained from Collaborative Informatics and Neuroimaging Suite.(http://coins.mrn.org/). Among the 173 individuals who were available for both structural data and resting state, 83 were found to have schizophrenia or schizoaffective. (hereafter SZ group, 9 37.31±13.97 years old). This was based on the Structured Clinical Interview for DSM-IV for Axis 1 DSM-IV Disorders(First et al., 1998). 90 of the individuals were non- psychiatric age-matched controls (control group, 37.51±11.40 years old). Individuals that were found to have bipolar disorder were excluded ( 9 individuals in total) Resting state echo planar image (EPI) volumes had 32 slices of 4mm 64x64 matrix with 4mm thickness (voxel size = 3x3x4mm), with repetition time (TR) of 2000ms and echo time (TE) of 29ms. A total of 150 volumes (5 minutes) were used in the analysis. High-resolution structural T1 volume was acquired as 176 sagittal slices of 256mm x 256mm with 1mm thickness (voxel size = 1x1x1mm, TR=2530ms and TE=3.25ms). Data Processing Data preprocessing and statistical analyses were conducted using FMRIB Software Library (FSL,) as well as Analysis of Functional NeuroImages (AFNI). The anatomical volume for each subject was skull stripped, segmented (gray matter, white matter and CSF), and registered to the MNI 2mm standard brain. First four EPI volumes were removed. Transient signal spikes were removed by de-spiking interpolation. To correct head motion, the volumes were linearly registered to the then first volume, through which six motion parameters and displacement distance between two consecutive volumes were estimated. Each of the resting state volumes was regressed by white matter and cerebrospinal fluid signal fluctuations as well as the six motion parameters. After smoothing with a 6mm FWHM Gaussian kernel, the volumes were resampled, spatially transformed and aligned to the MNI 2mm standard brain space. Through this registration, 10 12 affine parameters were created between rs-fMRI volume and MNI152 2mm space, so that a seed ROI can later be registered to each individual rs-fMRI space.
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